Breast Implant Techniques

There are many factors that will determine the outcome of your breast implant surgery and how your breasts look and feel after surgery. Breast implant surgery requires patients to decide in advance, certain surgical features, procedures and techniques for implant placement and positioning of the implant. Your decisions regarding technique will be dependent upon what type of implant you want, where you want your incision places (and post-surgical scars to appear, and whether you want your breast implants placed above or below the muscle tissue. The most common used techniques are explained here.

Breast Implant Types

Breast implants come in different forms, so patients must decide which shapes, sizes and material they want for breast surgery. Decades ago silicone filled implants were the only option available for patients. Now, patients can choose between saline-filled breast implants cased in silicone shells and filled with saline solution or sterile salt water. Silicone-filled implants, gummy bear implants or gel implants, and many other types. All breast implants have been improved over time, but the type of implant you select may dictate the location of the incision sites, the length and width of the incisions, whether your implants are pre-filled and whether they are inserted and surgically placed under the armpit, under the breast, through or behind the nipple or through the navel area. Your recovery time will also depend on the implant type chosen. Regarding the advantages and disadvantages of each type, please visit the other sections (types of breast implants).

Breast Implant Placement

Patients have a choice on where the breast implant is placed during the procedure. There are three basic positions where your doctor will need to create pockets in the chest cavity to place the implants during the surgery. When your surgeon asks you if you would like your implant above or below the muscle, you have to choose one of the three options; subglandular, subpectoral or submuscular. Each position has its advantages and disadvantages.

Subglandular Placement

The first breast implant placement possibility is the sub-glandular position. During this procedure, the surgeon places the breast implants in front of the pectoral muscles but behind the mammary gland.

Subglandular = Above or In Front of the Muscles

The are certain advantages of the subglandular technique. First it is easier for a surgeon to place the implants over the muscle, and since the muscles don't have to be manipulated there is reduced trauma, leading usually to less pain and faster recovery times for the patient. This advantage holds true for posterior surgeries.When implants have to be replaced years later, subglandular implants are easier to access, be replaced or removed.

One major disadvantage of this position is that the implant is most vulnerable and visible, meaning that if it ripples, it will be noticeably visible, especially if the patient is thin or has thin skin. In addition, if the implant shifts, it may be more apparent to the eye. Many opt against this position, because the implants can be heavy, depending on the size you choose, and the other options allow for more muscle tissue to support the weight and density of the implant over time.

Partial Submuscular Placement

Another possibility is the sub-pectoral position, in which the implants are partially set behind the muscles. Patients have two layers of pectoral muscles, and this position places the breast implants between the two layers of muscle, so the implant is partly covered by the 2/3 of the pectoralis major muscles.

Partial Submuscular = Between the Muscle

This position better protects the implant and makes any rippling less visible. Having your implant placed in this position is more painful and requires a longer healing time than the subglandular position. An advantage of this position is that the breast implant has partial muscle support. More than the sub-glandular position.

Complete Submuscular Placement

The final possible position is the submuscular position in which the surgeon places the breast implants behind the pectoralis muscles.

Complete Submuscular = Behind the Muscle

This placement is often referred to as "behind the muscle" and provides the most support as the implants are placed deeply behind both sets of muscles. This position is the most painful, but the implants are least visible and most supported over the longest period of time. In addition, the muscle holds the implant upright over time with age and gravity, so sagging is less apparent with the age of the patient and implants.

Ask your surgeon how each position may impact or interfere with annual mammography screenings, breast feeding, and physical activities.

Breast Implant Incisions

Breast implant surgery also requires patients to decide where they want their incisions made to place the breast implants during surgery. Incisions can be made in the armpit, at the crease below the breast, just below the nipple where skin coloration changes, or just above the bellybutton. Breast implant incision areas depend on implant types and incision areas may also determine the technique for implant placement during surgery. Incision sites will also dictate where you will have remaining incision scars after the surgery.

Notice the image above, which indicates incision placement on the body.

The armpit incision, where the incision is made in the armpit area is called the Transaxillary incision, and it has the advantage of leaving no visible scarring on the breast itself. During this technique, expandable breast implants are used. After the implants are properly placed through the armpits, the breast implants are filled to the desired cup size.

Incisions can also be made at the crease below the breast to place the breast implants during surgery. This incision technique is called the Inframammary Fold Incision. It is most often used to position a pre-filled implant. This was the most popular incision choice with earlier breast implant surgeries, and is still very popular for corrective surgery and some reconstructive breast surgeries.

The nipple incision technique to place breast implants is called the Peri-areolar Incision, and the incision is made where the darker skin of the nipple meets the lighter surrounding skin so that the changing skin coloration can mask the scar. This type of incision is popular for certain types of breast implant surgeries, such as corrective, reconstructive and surgeries that are performed to enlarge the breasts and change the size and shape of the nipples.

The belly button incision called is a newer technique called the TUBA (Trans-umbilical Breast Augmentation). This breast implant technique is rare, but gaining popularity with surgeons that perform this procedure. The TUBA technique requires the use of expandable implants that are filled after placement through the navel into the chest cavity.